Topic: Renal problems seen n pregnancy Faculty: Medicine Course: BSc RDT - 2nd year - Renal changes in pregnancy - UTI in pregnancy - Acute pyelonephritis in pregnancy - AKI in pregnancy

1. Renal problems seen in
pregnancy
Dr. Salman Ansari
Dept. of Pathology
Kanachur Institute of Medical Sciences

2. Contents
● Renal changes in pregnancy
● UTI in pregnancy
● Acute pyelonephritis in pregnancy
● AKI in pregnancy

3. Renal changes in pregnancy

4. Physiological adaptations during pregnancy

6. Kidney problems in pregnancy
- UTIs
- Hypertension
- Pre-eclampsia
- AKI

7. UTI in pregnancy

8. UTI in pregnancy
- Frequently seen in pregnant women
- Incompletely treated UTI can lead to pyelonephritis
Cause:
- Occurs due to urinary tract chances in pregnancy, such as
dilation of ureter due to compression of ureters by gravid
uterus
- Progesterone causes smooth muscle relaxation, leading to
dilation and urinary stasis and VUR(vesico-ureteric reflux)
increases
- Decrease in immune function in pregnancy

9. ● Asymptomatic bacteriuria(ASB): most significant risk
factor for developing UTI in pregnancy
● Defined as more than 100,000 organisms/ml on clean
catch urinalysis in an asymptomatic patient
● ASB screening should be done for all pregnant women at
the first prenatal visit
● Most common organism: E.coli. Others: Klebsiella,
Staphylococcus

10. Clinical features
- Asymptomatic
- History of frequent UTI
- Cystitis: pain or burning with micturition, frequency,
urgency
- Pyelonephritis: flank pain, fever, chills

11. Investigations
● Urinalysis, clean catch urine culture
● CBC
● Electrolytes
● Serum creatinine
● Fetal heart rate

12. Treatment
- ASB and cystitis are treated with antibiotics
- Choice depends upon results of urine culture and
sensitivity
- 3-day course of antibiotics
- Example: amoxicillin, ampicillin, cephalosporin
- Avoid nitrofurantoin and co-trimoxazole in first trimester
- Short course unlikely to harm fetus

13. Complication
● Pyelonephritis
● Sepsis
● Lung complications

14. Acute pyelonephritis in pregnancy

15. Acute pyelonephritis
● Bacterial infection causing inflammation of kidneys
● It is a complication of ascending UTI
● Can be complicated or uncomplicated
● It is considered complicated when it occurs in pregnant
patients

16. Causes
Gram-negative bacteria, most commonly E. coli
Others: Klebsiella, Proteus

17. Clinical features
Triad of:
1. Fever
2. Flank pain
3. nausea/vomiting
Other symptoms: dysuria, hematuria, fever

18. Investigations
● Urinary analysis: pyuria
● Nitrites present
● Hematuria
● Urine culture
● CBC
● RFT
● CECT abdomen and pelvis

19. Treatment
- Pyelonephritis in pregnancy is considered complicated
- Treated as inpatients
- Antibiotics, analgesics and antipyretics
- NSAIDs for pain and fever
- Initial antibiotic empirical and then changed based on urine C/S
results
- Intravenous antibiotics, such as piperacillin-tazobactam,
fluoroquinolones, cefepime
- Follow up urine culture, as well as follow up CT to identify risk
factors for future infections

20. Complications
● Renal abscess
● Perinephric abscess
● Renal vein thrombosis
● Sepsis
● Papillary necrosis
● Acute renal failure
● Emphysematous pyelonephritis

21. AKI in pregnancy(P-AKI)

22. Acute Kidney Injury in pregnancy
Acute kidney injury (AKI) is the abrupt loss of kidney
function, resulting in the retention of urea and other
nitrogenous waste products
“P-AKI”

23. Causes of AKI in pregnancy
In pregnancy, AKI can be due to:
● Fluid loss, due to severe vomiting(hyperemesis
gravidarum)
● Severe bacterial or viral infections
● Septic abortion
● preeclampsia/eclampsia
● Puerperal sepsis
● Postpartum hemorrhage

24. Causes of AKI in pregnancy
Obstetrical complications
Pregnancy-specific disorders
Miscellaneous(causes not related to pregnancy)

25. Obstetrical complications:
● Septic abortion
● Placenta previa
● bleeding(APH and PPH)
● IU fetal death
Pregnancy-specific disorders:
● Preeclampsia/eclampsia
● HELLP syndrome
● Hemolytic Uremic
Syndrome(HUS)
● Hyperemesis gravidarum
Miscellaneous(causes no
related to pregnancy):
● Dehydration
● Acute pyelonephritis
● Renal calculus

26. Timing of AKI with respect to the gestational period of the pregnancy.

27. Treatment of AKI in pregnancy
1) Supportive measures to preserve renal function
2) Dialysis
3) Treatment of underlying cause

28. 1) Supportive measures:
● Minimise renal injury, avoid nephrotoxic drugs
● Give IV fluids to maintain renal perfusion to prevent
hypovolemia
● Treat hypertension, hyperkalemia, metabolic acidosis and
anemia
● ACEI and ARBs: contraindicated
● Diuretics: not recommended due to high risk of
dehydration
● For HTN: first option is labetalol
● For hyperkalemia: treat with insulin

29. 2) dialysis:
● If unresponsive to medical treatment
● Hemodialysis is dialysis of choice
● Increased dialysis dose
● Maintain dialysis parameters in narrow range(bicarb:
25 mEq/L, sodium: 135 mEQ/L)

30. 3) treat underlying cause:
● Hyperemesis gravidarum: oral or IV rehydration
● UTI/pyelonephritis, septic abortion: antibiotics
● Treat preeclampsia, HELLP syndrome: deliver if >32
weeks
● TTP/aHUS: fresh frozen plasma, plasmapheresis
● Acute fatty liver of pregnancy: control blood glucose, give
FFP, blood transfusion

31. Questions
LE: Renal problems seen in pregnancy
SE: Pregnancy-associated renal diseases

32. References:
● Urinary Tract Infection in Pregnancy
● Acute Pyelonephritis
● AKI in pregnancy
● Acute kidney injury in pregnancy
Questions:
salman.s.ansari92@gmail.com